RESUMEN
Bilateral symmetric bone nodules were observed in the anterolateral first ribs of an infant with shaking injuries at autopsy. The location prompted diagnostic considerations of healing fractures versus anomalous articulations with pseudarthroses. The forensic pathologist worked with forensic anthropologists and pediatric radiologists to evaluate autopsy findings and compare premortem and postmortem X-rays. Gross examination of the bones by the pathologist and anthropologists confirmed bilateral, callus-like bone nodules in first-rib locations associated with pseudarthroses. Histologic examination of one of the bones further showed features most consistent with pseudarthrosis, not a healing fracture. Radiologists then compared multiple premortem and postmortem radiographs that showed no remodeling of the bone over a 2-week interval between the time of injury and death, which would be unexpected for a healing fracture in an infant. This multidisciplinary approach resulted in the appropriate diagnosis of pseudarthroses due to anomalous articulations, an uncommon finding in forensic pathology.
Asunto(s)
Callo Óseo/diagnóstico por imagen , Seudoartrosis/diagnóstico por imagen , Costillas/diagnóstico por imagen , Síndrome del Bebé Sacudido/complicaciones , Callo Óseo/patología , Encéfalo/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Patologia Forense , Curación de Fractura , Hematoma Subdural/diagnóstico por imagen , Homicidio , Humanos , Hipoxia-Isquemia Encefálica/etiología , Lactante , Seudoartrosis/patología , Radiografía , Costillas/patología , Síndrome del Bebé Sacudido/diagnóstico por imagenAsunto(s)
Huesos/lesiones , Cartílago/lesiones , Microscopía , Armas/clasificación , Heridas Punzantes/patología , HumanosRESUMEN
Sharp force trauma research lacks agreement on reported error rates for correctly identifying toolmark characteristics on bone and cartilage. This study provides error rates for determining blade class (serrated, partially serrated, nonserrated) and type of edge bevel (left, right, even). Three analysts examined cuts to a wax medium, cartilage, and bone using two types of microscopes. Additionally, the observers examined impressions taken from the wax medium and the cartilage. Overall, a total of 504 observations were performed. Serrated blades were distinguishable from nonserrated blades due to their patterned striations. Some difficulties were encountered in distinguishing serrated and partially serrated blades; however, when these groups were considered together as one classification type (serrated), classification accuracy improved from 79% to 96%. Classification accuracy for edge bevel was 65%. Error rates were similar when comparing direct observation of the cut marks versus indirect observation (impressions). Additionally, the type of microscope used did not affect error rates.